During this 5-year career development award Dr. Shiboski intends to integrate a study of oral disease in renal transplant recipients (RTRs) with further training in molecular epidemiology and immunology that would complement her background in general epidemiology and oral medicine. Dr. Shiboski proposes to recruit and follow over a 5-year period a cohort of RTRs to investigate the incidence of oral soft tissue disease in relation to 1) biological factors (time since transplantation, immunosuppressive regimen, diabetes); and 2) socio-demographic / behavioral factors (race, gender, dental insurance, dental care utilization). A secondary objective will be to identify the co-factors (predisposing, enabling, and need) that may explain dental care utilization in this population. RTRs (N = 360) will be recruited from the UCSF kidney post-transplant clinic, and followed at 1-year intervals. Measurements will include an oral soft tissue examination, evaluation of periodontal parameters, vertical bitewing radiographs, assessment of oral treatment needs, and an interview. Participants will be examined at the UCSF Stomatology Clinical Center. This study is the first and necessary step for the development of subsequent studies to investigate how oral disease may relate to graft outcomes and systemic conditions within this group of medically compromised patients. The training aspect of the award will be under the guidance of two mentors and a clinical adviser. Dr. John Greenspan will assist the candidate in learning aspects of molecular immunopathology and immunohistochemistry that are relevant to her research area. Dr. Ira Tager will advise the candidate about methodologic difficulties inherent in a longitudinal study of immunosuppressed subjects with complex medical histories. Dr. Laurie MacPhail, who received a Mid-career Investigator Award in Patient-Oriented Research (K24) in 1999, will act as clinical adviser to Dr. Shiboski. The candidate earned a PhD in epidemiology from the University of California, Berkeley, and received post-graduate training in oral medicine at UCSF as part of an individual Dentist Scientist Award. The proposed career development award would allow Dr. Shiboski to evolve from the post-doctoral level to the level of independent investigator. The candidate intends to devote 80 percent effort to the proposed project.